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Khalpey Z, Aslam U, Wilson P, Deckwa J, Kumar U. Prophylactic Left Atrial Appendage Ligation During Coronary Artery Bypass Graft Surgery Allows Safe Avoidance of Anticoagulation Regardless of Postoperative Atrial Fibrillation. Cureus 2024; 16:e59876. [PMID: 38854212 PMCID: PMC11157991 DOI: 10.7759/cureus.59876] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/11/2024] Open
Abstract
Background New-onset postoperative atrial fibrillation (POAF) is the most common arrhythmia following cardiac surgery. POAF increases the risk of thromboembolism and stroke, as well as morbidity and mortality more generally. Despite evidence from the landmark PROTECT-AF and PREVAIL trials, left atrial appendage ligation (LAAL) is not routinely performed for thromboembolism prophylaxis in POAF, and anticoagulation remains the standard of care along with dual antiplatelet therapy. This study evaluated the efficacy of concomitant LAAL in eliminating the need for postoperative anticoagulation, regardless of POAF development, in patients undergoing coronary artery bypass grafting (CABG). Methods Between 2019 and 2021, 130 patients were selected to undergo concomitant LAAL while undergoing CABG surgery. Patients were then monitored for the incidence of new-onset POAF, and anticoagulation was strictly avoided for this indication. Demographic and outcome data were collected, with endpoints including transient ischemic attack (TIA) or stroke, death, and readmission within one year, as well as the length of hospital and intensive care unit (ICU) admissions. Results POAF occurred in 37 patients (28.5%), consistent with previous reports. However, none of the POAF patients experienced TIA or stroke during the one-year follow-up period, compared to 2 (2.15%) in the non-POAF group, a typical rate of postoperative stroke in such a patient population. No significant differences were observed between POAF and non-POAF cohorts in one-year stroke, all-cause mortality, readmission rates, or total hospital stay. Interestingly, the POAF cohort had a significantly longer mean ICU stay (4.24 vs 3.37 days, p = 0.0219), possibly due to the time required for arrhythmia control before discharge. The study population had a high mean CHA2DS2-VASc score (2.81), indicating an increased risk of thromboembolism, and a high mean HAS-BLED score, suggesting an elevated bleeding risk with anticoagulation. Conclusions LAAL appears to be an effective adjunct to CABG for thromboembolism prophylaxis in POAF. Formal anticoagulation was avoided in this study, with no significant differences in adverse events between POAF and non-POAF groups, suggesting that LAAL may be a suitable alternative to anticoagulation, especially in high-risk patients (e.g., those with elevated CHA2DS2-VASc or HAS-BLED scores). The safety and efficacy of this approach should be corroborated by larger randomized studies, such as the ongoing LeAAPS trial. LAAL during CABG may help reduce the risk of bleeding complications associated with anticoagulation while maintaining protection against thromboembolic events in patients who develop POAF.
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Affiliation(s)
- Zain Khalpey
- Department of Cardiothoracic Surgery, HonorHealth, Scottsdale, USA
| | - Usman Aslam
- Department of Cardiothoracic Surgery, HonorHealth, Scottsdale, USA
- Department of General Surgery, HonorHealth, Phoenix, USA
| | - Parker Wilson
- Department of Internal Medicine, Baylor University Medical Center, Dallas, USA
| | - Jessa Deckwa
- Department of Research, Nihon Kohden Digital Health Solutions, Irvine, USA
| | - Ujjawal Kumar
- Department of Cardiothoracic Surgery, HonorHealth, Scottsdale, USA
- School of Clinical Medicine, University of Cambridge, Cambridge, GBR
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Bani Hani A, Salhiyyah K, Salameh M, Abu Abeeleh M, Al Smady M, Al Rawashdeh M, Abu Fares H, Al-Ammouri I. Atrial Septal Defect Repair in Adolescent and Adult Patients, a Cross Sectional Study at Jordan University Hospital, a Tertiary Hospital in a Developing Country. Int J Gen Med 2022; 15:3517-3524. [PMID: 35392029 PMCID: PMC8979831 DOI: 10.2147/ijgm.s356502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/08/2022] [Indexed: 11/27/2022] Open
Abstract
Objective We aim to report our heart team's experience in repair of Secundum atrial septal defect (ASD) in adolescent and adult patients at Jordan University Hospital (JUH). Methodology A retrospective observational study of 44 patients who underwent secundum ASD closure by transcatheter closure (TCC) or Minimally Invasive Cardiac Surgery (MICS) at JUH. Patients who were treated at an age of 14 years or older regardless of the age of diagnosis were included. SPSS and Microsoft Excel were used to analyze the data. Results A total of 44 patients with secundum ASD were treated during the period of (January 2015 and December 2019). The mean age was 34.1 (±14.3) years. Thirty-four patients underwent TCC, 9 underwent surgical closure and one had a hybrid procedure. We had no mortality and 2 minor morbidities. After a mean follow-up period of 13.2-/+13.6 months, most patients experienced improved symptoms, and there was a significant reduction of right ventricular dimension from 33.1 (±8.74) to 24 (±4.67) mm (p=0.0001). Conclusion ASD closure whether TCC or MICS is a safe procedure with very low morbidity. A heart team approach is a necessity in the era of advances in both MICS surgery and TCC approach. A heart team provides the patients with a variety of safe and cosmetic solutions that allow the patients to have a fast management and recovery phase in rapid time through providing the merits and avoiding the complications of each modality, the team allows low volume centers in developing countries to achieve an excellent outcome.
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Affiliation(s)
- Amjad Bani Hani
- Department of General Surgery, Division of Cardiac Surgery, The University of Jordan, Amman, Jordan
| | - Kareem Salhiyyah
- Department of Cardiac Science, Middle East University, Amman, Jordan
| | - Mohammad Salameh
- Department of General Surgery, Division of Cardiac Surgery, The University of Jordan, Amman, Jordan
| | - Mahmoud Abu Abeeleh
- Department of General Surgery, Division of Cardiac Surgery, The University of Jordan, Amman, Jordan
| | - Moaath Al Smady
- Department of General Surgery, Division of Cardiac Surgery, The University of Jordan, Amman, Jordan
| | - Mohammad Al Rawashdeh
- Department of Pediatrics, Division of Pediatric Cardiology, The University of Jordan, Amman, Jordan
| | - Hala Abu Fares
- Department of Pediatrics, Division of Pediatric Cardiology, The University of Jordan, Amman, Jordan
| | - Iyad Al-Ammouri
- Department of Pediatrics, Division of Pediatric Cardiology, The University of Jordan, Amman, Jordan
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Augoustides JG. Protecting the Central Nervous System During Cardiac Surgery. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00022-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kaneko S, Ichinomiya T, Sato S, Sekino M, Murata H, Hara T. Effect of perioperative acetaminophen on body temperature after cardiovascular surgery with cardiopulmonary bypass: A single-center retrospective study. Ann Card Anaesth 2021; 24:155-162. [PMID: 33884970 PMCID: PMC8253030 DOI: 10.4103/aca.aca_153_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Context: Postoperative hyperthermia, which may lead to cognitive decline, is a common complication of cardiovascular surgery with cardiopulmonary bypass (CPB). Aims: The aim of this study was to examine the effectiveness of perioperative intravenous acetaminophen on body temperature in adult patients after cardiovascular surgery with CPB. Settings and Design: This was a single-center retrospective study focusing on adult patients who underwent elective cardiovascular surgery with CPB at a university hospital in Japan. Subjects and Methods: Patients were divided into two groups based on whether they received acetaminophen perioperatively. In the acetaminophen group, 15 mg/kg intravenous acetaminophen solution was infused at 30 min after discontinuation of CPB and every 6 h after intensive care unit (ICU) admission. Statistical Analysis Used: The primary outcome was the maximum axillary temperature within 12 h after ICU admission. The effects of acetaminophen on postoperative body temperature were estimated by the standardization and inverse probability weighting using propensity scores. Results: A total of 201 patients were included in the final analysis (acetaminophen group, n = 101; non-acetaminophen group, n = 100). The maximum axillary temperature within 12 h after ICU admission was 37.20 ± 0.54°C in the acetaminophen group and 37.78 ± 0.59°C in the non-acetaminophen group. Acetaminophen lowered the standardized mean of primary endpoint (−0.54°C, 95% confidence interval, −0.69 to −0.38) compared to non-acetaminophen. Conclusions: Perioperative intravenous acetaminophen inhibited body temperature elevation after cardiovascular surgery with CPB, compared with the non-acetaminophen group.
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Affiliation(s)
- Shohei Kaneko
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Taiga Ichinomiya
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shuntaro Sato
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Motohiro Sekino
- Division of Intensive Care, Nagasaki University Hospital, Nagasaki, Japan
| | - Hiroaki Murata
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tetsuya Hara
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Neurological Complications in Cardiac Surgery. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00344-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Aldag M, Kocaaslan C, Bademci MS, Yildiz Z, Kahraman A, Oztekin A, Yilmaz M, Kehlibar T, Ketenci B, Aydin E. Consequence of Ischemic Stroke after Coronary Surgery with Cardiopulmonary Bypass According to Stroke Subtypes. Braz J Cardiovasc Surg 2019; 33:462-468. [PMID: 30517254 PMCID: PMC6257531 DOI: 10.21470/1678-9741-2018-0086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/08/2018] [Indexed: 11/05/2022] Open
Abstract
Introduction The aim of this study was to determine the outcomes of patients developing
ischemic stroke after coronary artery bypass grafting (CABG). Methods From March 2012 to January 2017, 5380 consecutive patients undergoing
elective coronary surgery were analyzed. Ninety-five patients who developed
ischemic strokes after on-pump coronary surgery were included in the study,
retrospectively. The cohort was divided into four subgroups [total anterior
circulation infarction (TACI), partial anterior circulation infarction
(PACI), posterior circulation infarction (POCI), and lacunar infarction
(LACI)] according to the Oxfordshire Community Stroke Project (OCSP)
classification. The primary endpoints were in-hospital mortality, total
mortality, and survival analysis over an average of 30 months of follow-up.
The secondary endpoints were the extent of disability and dependency
according to modified Rankin Scale (mRS). Results The incidence of stroke was 1.76% (n=95). The median age was
62.03±10.06 years and 68 (71.6%) patients were male. The groups were
as follows: TACI (n=17, 17.9%), PACI (n=47, 49.5%), POCI (n=20, 21.1%), and
LACI (n=11, 11.6%). Twenty-eight (29.5%) patients died in hospital and 34
(35.8%) deaths occurred. The overall mortality rate of the TACI group was
significantly higher than that of the LACI group (64.7% vs.
27.3%, P=0.041). The mean mRS score of the TACI group was
significantly higher than that of the other groups
(P=0.003). Conclusion Patients in the TACI group had higher in-hospital and cumulative mortality
rates and higher mRS scores. We believe that use of the OCSP classification
and the mRS may render it possible to predict the outcomes of stroke after
coronary surgery.
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Affiliation(s)
- Mustafa Aldag
- Department of Cardiovascular Surgery, Istanbul Medeniyet University Medical Faculty, Istanbul, Turkey
| | - Cemal Kocaaslan
- Department of Cardiovascular Surgery, Istanbul Medeniyet University Medical Faculty, Istanbul, Turkey
| | - Mehmet Senel Bademci
- Department of Cardiovascular Surgery, Istanbul Medeniyet University Medical Faculty, Istanbul, Turkey
| | - Zeynep Yildiz
- Department of Neurology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Aydin Kahraman
- Department of Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Oztekin
- Department of Cardiovascular Surgery, Istanbul Medeniyet University Medical Faculty, Istanbul, Turkey
| | - Mehmet Yilmaz
- Department of Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Tamer Kehlibar
- Department of Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Bulend Ketenci
- Department of Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ebuzer Aydin
- Department of Cardiovascular Surgery, Istanbul Medeniyet University Medical Faculty, Istanbul, Turkey
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Paone G. Aortic clamping and stroke: Because two isn't worse doesn't mean one isn't better. J Thorac Cardiovasc Surg 2018; 156:1458-1459. [PMID: 29691048 DOI: 10.1016/j.jtcvs.2018.03.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 03/27/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Gaetano Paone
- Division of Cardiac Surgery, Henry Ford Hospital, Detroit, Mich.
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Liu Q, Xue FS, Yang GZ, Liu YY. Associations of Gastrointestinal Complications and Adverse Outcomes After Cardiac Surgery. J Cardiothorac Vasc Anesth 2018; 32:e84-e85. [PMID: 29573955 DOI: 10.1053/j.jvca.2018.02.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Qing Liu
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Gui-Zhen Yang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ya-Yang Liu
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Impact of Modified Transesophageal Echocardiography on Mortality and Stroke after Cardiac Surgery: A Large Cohort Study. Int J Vasc Med 2017; 2017:1857069. [PMID: 29085679 PMCID: PMC5611872 DOI: 10.1155/2017/1857069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/27/2017] [Accepted: 07/18/2017] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to investigate the impact of perioperative screening with modified transesophageal echocardiography (A-View method). We compared, in consecutive patients who underwent cardiac surgery between 2006 and 2014, 30-day mortality and in-hospital stroke incidence, operated either with perioperative modified TEE screening (intervention group) or only with conventional TEE screening (control group). Of the 8,605 study patients, modified TEE was applied in 1,391 patients (16.2%). Patients in the intervention group were on average older (71 versus 68 years, p < 0.001) and more often females (31.0% versus 28.0%, p < 0.001) and had a higher predicted mortality (EuroSCORE I: 5.9% versus 4.0%, p < 0.001). The observed 30-day mortality was 2.2% and 2.5% in both groups, respectively, with multivariable and propensity-score adjusted relative risks (RRs) of 0.70 (95% CI: 0.50–1.00, p = 0.05) and 0.67 (95% CI: 0.45–0.98, p = 0.04). In-hospital stroke was 2.9% and 2.1% in both groups, respectively, with adjusted RRs of 1.03 (95% CI: 0.73–1.45) and 1.01 (95% CI: 0.71–1.43). In patients undergoing cardiac surgery, use of perioperative screening for aortic atherosclerosis with modified TEE was associated with lower postoperative mortality, but not stroke, as compared to patients operated on without such screening.
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Kodaira M, Kawamura A, Okamoto K, Kanazawa H, Minakata Y, Murata M, Shimizu H, Fukuda K. Comparison of Clinical Outcomes After Transcatheter vs. Minimally Invasive Cardiac Surgery Closure for Atrial Septal Defect. Circ J 2017; 81:543-551. [DOI: 10.1253/circj.cj-16-0904] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Masaki Kodaira
- Department of Cardiology, Keio University School of Medicine
- Department of Cardiology, Ashikaga Red Cross Hospital
| | - Akio Kawamura
- Department of Cardiology, Keio University School of Medicine
- Department of Cardiology, National Defense Medical College
| | - Kazuma Okamoto
- Department of Cardiovascular Surgery, Keio University School of Medicine
| | | | - Yugo Minakata
- Department of Cardiology, Keio University School of Medicine
| | - Mitsushige Murata
- Department of Cardiology, Keio University School of Medicine
- Department of Laboratory Medicine, Keio University School of Medicine
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University School of Medicine
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine
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